CASE PRESENTATION: A 61 years of man with a history of lung cancer was admitted to our emergency service with suddenly occurred paraplegia. Cerebral, thoracic and lumbar magnetic resonance imaging was performed due to neurological complaints. Intradural, intramedullary spinal metastasis was demonstrated at T1A, T2A weighted sagittal images in thoracic region MRI, leptomeningeal involvement was also observed. There was no patological change in cerebral MRI. Lung squamous cell carcinoma had been diagnosed with bronchoscopy 5 months before admission of emergency department. Urgent radiotherapy was planned for treatment.

DISCUSSION: Metastases to the spine can involve the bone, epidural space, leptomeninges, and spinal cord. The spine is the third most common site for metastatic disease, following the lung and the liver and the most common osseous site (1). Intramedullary spinal cord metastasis compromises only 1-3% of all intramedullary spinal cord neoplasms (2). In our case, only intradural, intramedullary metastasis with leptomeningeal involvement were observed, there is no metastasis findings in other part of body. Metastatic intramedullary spinal cord tumors cause pain, sensory disturbance, weakness, and sphincter dysfunction due to edema, distortion and compression of the spinal cord parenchyma (2). Despite deterioration of neurological status is relatively rapid within a period of days to weeks in ISCM, symptoms typically present a slow progression in primary intramedullary tumors (2). Sudden paraplegia, sphincter dysfunction was occurred in days in our patients.

CONCLUSIONS: In conclusion, despite to the rare metastasis ratio of lung cancer in spinal cord, intramedullary metastasis should be kept in mind in patients with neurological deterioration. Imaging plays an important role in diagnosis of spinal metastasis.

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